tbuckley/cabot-search huggingface dataset:
Abstract 9563: Intravenously Infused Extracellular Vesicles Preserve Function of Anthracycline-Treated Hearts
Authors: Manon Desgres, Lorena Petrusca, Gwennhael Autret, Chloé Pezzana, Celine Marigny, Ashley Peuffier, Valerie Bellamy, Pierre Croisille, Albert Hagege, Bertrand Tavitian, Jean-Sebastien Silvestre, Philippe Menasche
Journal: Circulation (2022)

Introduction: Current treatments of chemotherapy-induced cardiomyopathy (CCM) are of limited efficacy. Hypothesis: Extracellular vesicles (EV) might represent a new therapeutic option. Methods: Male immunocompetent mice were subjected to 3 intraperitoneal (IP) injections of doxorubicin (DOX, 4mg/kg) followed by 3 sequential intravenous injections of EV (10x10 9 /injection) collected from human induced pluripotent stem cell (hiPSC)-differentiated cardiovascular progenitor cells. Outcomes were assessed 8-11 weeks after the onset of DOX treatment on MRI and compared with those of mice injected with saline (controls) or DOX-untreated (sham). Explanted hearts were subjected to transcriptomics. Next, female rats received 5 IP injections of DOX (3mg/kg) followed by 3 IV injections of EV (33x10 9 /injection) similar to those of the mouse study except that they had been GMP-manufactured to be of clinical grade. Control rats were saline-injected or DOX-untreated (sham). Outcomes were assessed 1 month after the onset of DOX treatment on echocardiography. In additional in vitro experiments, hiPSC-derived cardiomyocytes were stressed by DOX w/wo EV and assessed for ATP content. Results: In mice, DOX+saline-injected hearts (n=14) incurred a significant decline in basal (global, epi- and endocardial) circumferential strain compared with the 14 sham mice (p=0.04 for each) while EV (n=11) preserved these indices which did not significantly differ from those of sham mice. Global longitudinal strain followed a similar pattern. EV also upregulated genes involved in the limitation of cardiac remodeling and preservation of contractile function. In rats, LV endsystolic volumes were significantly increased in saline-injected hearts (n=11) compared with the 6 sham (p=0.03) but were preserved after EV injections (n=12). Likewise, the percentages of "responder" rats which did not increase their enddiastolic LV volumes by more than 5% from their post-DOX pre-treatment values were 58% vs . 28% in EV- and saline-injected hearts, respectively. In vitro , EV increased ATP levels of DOX-stressed cardiomyocytes by 30% compared to placebo. Conclusions: The cardioprotective effects of IV-injected EV make them an attractive user-friendly option for the treatment of CCM.
Abstract 9520: Referral From a Regional Facility is Associated With Higher One Year Mortality in Patients With Infected Cardiovascular Implantable Electronic Devices
Authors: Waseem Farooq, Mohamad Kalot, Ronak Bahuva, Rohan Pandey, Aalia Khan, David Kerling, Hamza Aftab, Shilpi Gupta, Morgan Smith, Alexander Kovacs, Ali Mir, Ram Amuthan, Umesh C Sharma
Journal: Circulation (2022)

Introduction: The use of Cardiac Implantable Electronic Devices (CIEDs) has increased considerably over the past few decades driven by evolving device technology and expanding indications. CIED infections are an important consideration given their clinical and economic impact. Hypothesis: This study sought to assess the impact of regional referral versus direct presentation to expert tertiary care facility in patients with infected CIED. Methods: Retrospective analysis of a regional database of patients presenting with CIED infection to medical centers across Western New York, USA from 2012 - 2020. We compared the 1-year mortality among the patients presenting directly to expert tertiary care facilities versus those referred from regional facilities. Results: A total of 296 patients (74% male, age 69.2 ± 13.7) were included in the study of which 290 (98%) underwent CIED extraction (Table 1). Of the 296 patients, 99 (33.4%) presented from regional centers and 197 (66.5%) presented directly to expert centers. 24 (24.2%) patients referred from regional centers died within one year as compared to 28 (14.2%) patients presenting to expert tertiary care facilities (p=0.02) (Figure 1). Conclusions: In patients with CIED infections, referral from a regional facility is associated with worse outcomes. This may relate to the delay in definite management and underscores the importance of early identification and the need for a robust referral infrastructure to improve patient outcomes.
Abstract 9511: Sex Difference of Fibrous Cap Collagen Content in Patients With Coronary Artery Disease: An Intravascular Polarimetry Study
Authors: Kenichiro Otuska, laurens van zandvoort, Martin Villiger, Seemantini Nadkarni, Atsushi Tanaka, Daiju Fukuda, Joost Daemen, Brett E Bouma
Journal: Circulation (2022)

Introduction: Intracoronary optical coherence tomography (OCT) polarimetry (OCT-polarimetry) enables to provide polarization properties (birefringence and depolarization) of the tissues in the coronary arterial wall together with coronary plaque microstructures. Collagen and smooth muscle cells exhibit birefringence, while depolarization is increased by the presence of macrophages and lipid components. Hypothesis: We hypothesized that there exists sex difference in collagen content of coronary plaques by measuring polarization properties of the coronary arterial walls. Methods: We analyzed 41 coronary lesions imaged with intracoronary OCT-polarimetry in 38 patients with CAD (ACS, n = 24 and chronic CAD, n = 14). Conventional OCT analysis included lesion-level qualitative analysis (fibrous cap thickness, presence of plaque rupture, macrophages, thrombus, layered plaque, cholesterol crystals) and quantitative analysis (lipid-burden index, calcium arc and length, and vessel lumen area). Polarimetric analysis was performed on OCT cross-sectional images with the thinnest fibrous cap of the lesion, blinded to the conventional OCT analysis results. The measurements were compared between male (n = 27) and female (n =11) using a generalized linear model with generalized estimating equations. Results: In this study population, ACS was more frequently observed in female patients compared to male patients (91% v.s. 52%, p&lt;0.05). There was no significant difference in the conventional OCT measurements, while male patients exhibited a greater lipid-index compared to female patients. Although depolarization was comparable between the two groups, significantly lower birefringence was observed in female patients as compared to male patients (p-values &lt; 0.05). A GEE model demonstrated that birefringence was independently and positively associated with male sex (beta, 1.4; 95% confidence interval 0,42-2,4; p =0.005), even after adjusting for age, ACS, and lipid-burden index. Conclusions: This study is the first to report sex difference in the polarization properties of coronary plaque fibrous cap. Intracoronary OCT-polarimetry opens the possibility of elucidating the mechanism of plaque destabilization through collagen remodeling.
Abstract 9584: Preoperative Characteristics Predict Death and Pump Replacement in Patients With HeartMate 3 Left-Ventricular Assist Devices
Authors: Bret L Pinsker, Fabian Jimenez Contreras, Jacob Schroder, Benjamin Bryner, Jason N Katz, Stuart D Russell, Carmelo A Milano
Journal: Circulation (2022)

Introduction: There is limited data examining predictors of outcome in patients with HeartMate 3 (HM3) LVAD. We sought to examine factors that predict pump replacement and death in patients with HM3 LVAD. Hypothesis: Traditional risk factors in older LVAD models may be unassociated with pump replacement and death in patients with HM3 LVAD. Methods: Patients that underwent HM3 LVAD implantation from 2015 to 2020 were identified from a single tertiary care center. Records were reviewed for demographic/clinical characteristics at LVAD implantation and a primary outcome of LVAD replacement or death. Predictors of outcome were identified using univariable Cox regression. Kaplan Meier (KM) analysis and log-rank test were used to assess outcome-free survival based on pre-operative BMI and albumin. Results: A total of 298 patients that met inclusion criteria were identified. Over a median follow-up of 2.3 years, 97 patients (33%) experienced a primary outcome. Predictors of outcome included age, peripheral vascular disease, ECMO prior to LVAD implantation, and pre-operative creatinine and albumin levels. BMI was not predictive of the primary outcome (Table 1). Outcome-free survival was different among patients with and without pre-operative hypoalbuminemia, but unassociated with differences in BMI (Figure 1). Conclusions: This is one of the largest single-institution cohorts that has examined predictors of adverse outcomes in patients with HM3 LVAD. Optimizing pre-operative nutrition (as reflected by albumin) may help prevent adverse outcomes in this population. Lastly, HM3 LVAD may be a safe option in obese patients who would otherwise not be candidates for transplantation.
Abstract 9422: Tandem Deep Learning and Logistic Regression Models to Optimize Hypertrophic Cardiomyopathy Detection in Routine Clinical Practice
Authors: Maren Maanja, Konstantinos Siontis, Jeffrey B Geske, Michael J Ackerman, Adelaide A Arruda-Olson, Steve R Ommen, Zachi Attia, Paul Friedman, Peter A Noseworthy
Journal: Circulation (2022)

Background: An electrocardiogram (ECG)-based artificial intelligence (AI) algorithm has shown good performance in detecting hypertrophic cardiomyopathy (HCM AI-score). However, its clinical application may be challenging due to the low disease prevalence and potentially high false-positive rate when screening unenriched cohorts. Aims: To identify clinical characteristics associated with false-positive HCM AI-score results to improve screening tool application. Methods: From a cohort of 20,677 patients with a digital 12-lead ECG in routine clinical practice in 2021, we performed a detailed chart review of the 200 patients with highest HCM AI-score to determine their HCM status and collect clinical data. Stepwise forward logistic regression was used to create a clinical variable-based “candidacy for HCM screening” score (CHS score), differentiating true- and likely true-positive from likely false-positive HCM AI-score results. We then validated the CHS score in 200 patients with the highest HCM AI-scores from an independent cohort of 15,147 patients with an ECG in 2022. Results: Among the 200 patients in 2021 (median age 71 years, 48% female), 96 (48%) were likely false-positive HCM AI-score results, 71 (36%) definite or likely true-positive results, and 33 (16%) indeterminate. The CHS score included a history of surgical septal myectomy, coronary artery bypass graft surgery, cardiac valve replacement, and pacemaker, and had an AUC of 0.88 (95% CI 0.83-0.92) for the differentiation of true- versus false-positive AI results. In the 2022 cohort, the CHS score had an AUC of 0.82 (95% CI 0.76 - 0.88). After limiting the cohort to HCM candidates identified by the CHS score, the false-positive results rate was reduced to 27/114 (24%). Conclusions: By applying the CHS score to patients with positive HCM AI-screening results, the false-positive rate decreased from 49% to 24%. Utilizing a clinical model used in tandem with an AI model improved diagnostic yield.
Abstract 9447: The Clinical Penetrance of the Transthyretin V122I Variant in Older Black Patients With Heart Failure: The Screening for Cardiac Amyloidosis With Nuclear Imaging in Minority Populations Study
Authors: Avni Madhani, Natalia Sabogal, Daniel Massillon, Ludwine D Paul, Carlos Rodriguez, Denise Fine, Stephen Helmke, Morgan Winburn, Damian Kurian, Farbod Raiszadeh, Sergio Teruya, Elizabeth Cohn, Andrew J Einstein, Edward J Miller, Lawreen H Connors, Mathew S Maurer, Frederick L Ruberg
Journal: Circulation (2022)

Introduction: Transthyretin amyloid cardiomyopathy (ATTR-CM) is an underdiagnosed cause of heart failure (HF) among patients aged &gt; 60 years. While the V122I variant that is associated with hereditary ATTR-CM is present in 3.4% of self-identified Black individuals in the US (or 1.5 million people), the phenotypic penetrance of this allele remains incompletely defined owing to age-dependent expression and limited methods for disease ascertainment. Methods: The Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations (SCAN-MP) study is a currently accruing multisite cohort designed to determine the prevalence of ATTR-CM using Tc-99m-Pyrophosphate imaging in older (age &gt; 60 years) Black and Hispanic individuals with HF. TTR genotype is determined by 4-exon targeted PCR, while functional, biochemical, and echocardiographic testing is performed. Data are presented here as an interim analysis performed using Kruskal-Wallis testing for the first 240 self-identified Black participants. Results: The prevalence of V122I was 6.7% (n=16 carriers of whom 7 had ATTR-CM), yielding a phenotypic penetrance of 44% (95% CI 20%, 70%) at a median age of 82 (IQR 74, 85) years. Allele carriers with ATTR-CM (Group 3) were older and more likely male, with lower 6-minute walk distance and LVEF, when compared to carriers without ATTR-CM (Group 2, Table) or wild-type, non-amyloid HF controls (Group 1). Other functional, biochemical, and echocardiographic parameters were predictably different between Group 3 and the other groups but similar between Groups 1 and 2 except for prealbumin levels (Group 1: 25 mg/dl vs. Group 2: 20.5 mg/dl, p &lt; 0.05). Conclusion: The clinical penetrance of V122I among elderly Black individuals with HF and a median age of 82 years was 44%, suggesting that genotype alone is insufficient to infer ATTR-CM as the cause of HF in this clinical context. Prealbumin concentration may be useful to identify ATTR-CM in V122I carriers.
Abstract 9502: Sexual Minority Adults’ Perceptions of a Multi-Component Intervention for CVD Risk Reduction
Authors: Vincent Pepe, Danny Doan, Yashika Sharma, Maureen George, Billy A Caceres
Journal: Circulation (2022)

Introduction: Sexual minority (SM; e.g., gay, lesbian, bisexual) adults have a higher prevalence of risk factors for cardiovascular disease (CVD) compared to heterosexual adults, which is attributed to their increased exposure to minority stressors (e.g., experiences of discrimination). Yet, there are no evidence-based interventions for CVD risk reduction tailored to the unique needs of SM adults. Our goal was to inform the development of a tailored intervention for CVD risk reduction in middle-aged (ages 40-64) SM adults. Methods: We conducted a qualitative descriptive study to understand the perceptions of SM adults on their risk of CVD and identify their preferences for an intervention. We recruited an online sample of middle-aged SM adults who lived in the United States and reported no history of CVD. During one-on-one semi-structured interviews, participants were presented a sample multi-component intervention that combined elements of existing interventions for minority stress and CVD risk reduction. Transcripts were independently coded using directed content analysis to create a codebook. Codes were grouped into cognitive, behavioral, and environmental themes guided by Social Cognitive Theory. Results: The sample included 23 participants with a mean age of 52.0 (±7.2) years. Approximately 52% were female and 61% were White. Cognitive theme: Participants acknowledged the importance of their sexual identity and cardiovascular health but lacked insight into the elevated CVD risk that has been observed in SM adults. Behavioral theme: They were willing to join an intervention to reduce their CVD risk if it did not require dramatic lifestyle changes. Environmental theme: Participants preferred a virtual, synchronous, group intervention no longer than 12 weeks. They indicated convenience, socialization, and comprehensiveness were main factors informing intervention delivery preferences. All participants approved of the sample intervention, particularly stress-reduction components. Conclusions: Gaps in knowledge related to CVD risk among SM adults were identified. Findings provide important knowledge that should be considered in designing tailored interventions for CVD risk reduction in SM adults.
Abstract 278: Association Between Hospital Extracorporeal Life Support Volume And Outcome In Out-of-hospital Cardiac Arrest Patients
Authors: Seul Ki Choi, Kyoung J Song, Ki Jeong Hong, Young Sun Ro, Won pyo Hong, Stephen Gyung Won LEE, Hyouk jae Lim, Ki Hong Kim, Yong Joo Park, Hanna Yoon, Gyeongmin Lee, Kang bin Lee, Eunsil Ko, Ho Kyung Sung
Journal: Circulation (2022)

Background: The application of Extracorporeal Membrane Oxygenation(ECMO) and Extracorporeal Life support(ECLS) in hospitals is increasing. In the case of high-level skills, the volume of a specific treatment may be related to the outcome. There has been no discussion on the effect of the increasing utilization volume of ECLS in hospitals on the outcome of OHCA patients. Objectives: We want to determine how the hospital's ECMO volume affects the outcome of the overall OHCA patient visits to the hospital. Methods: We used Korean National OHCA Registry, and performed a cross-sectional study that collected adult EMS-treated cardiac origin OHCA patients between 2015 and 2019 in Seoul. We profiled the number of times ECLS, and hospitals that performed more than 20 times during the study period were regarded as high volume centers (HV centers), and the rest hospitals were defined as low volume centers (LV centers). The primary outcome was a neurologically good outcome (CPC 1 or CPC 2). The secondary outcome was survival at discharge. OHCA patients who visited the two groups were compared using a logistic regression model, and an interaction analysis was performed on the ECMO volume of the hospital and whether the patient had received ECLS. Results: Of the 17,248 included, 3,731 (21.63%) were transported to the HV center. The frequency of good neurological survival was not significant in the group transported to the HV center(aOR 1.08, 95% CI 0.9 - 1.29), but the frequency of survival to discharge was significantly higher(aOR 1.19, 95% CI 1.03 - 1.37). According to interaction analysis, OHCA patients who received ECLS at the HV center showed a significantly better neurological survival outcome(aOR 2.217, 95% CI 1.15 - 4.28), and the OHCA patients transported to the HV center, not receive ECLS had significantly better survival to discharge rates than those transported to the LV center (aOR 1.16, 95% CI 1.01 - 1.34). Conclusions: OHCA patients who were transported and received ECLS to hospitals with high ECMO volumes center had a significantly better neurological outcome. Those who were transported to the high-volume center had a better survival to discharge rate than patients transported to the low-volume one, even if they did not receive ECLS.
Abstract 9395: Natural History of Myocardial Injury Following Covid-19 Vaccine Associated Myocarditis
Authors: Muhammad Mustafa Alhussein, Mohamad Rabbani, Bradley Sarak, Steven Dykstra, Dina Labib, Jacqueline Flewitt, Carmen Lydell, Andrew G Howarth, Neil G Filipchuk, Angela Kealey, Jillian Colbert, Nita Guron, Louis Kolman, Naeem Merchant, Murad Bandali, Mike Bristow, James A White
Journal: Circulation (2022)

Introduction: Acute myocarditis is a rare complication of mRNA-based COVID-19 vaccination. The natural history and clinical sequalae of this complication are of critical importance to estimate the impact on population health. Objective: To study the impact of COVID-19 vaccine associated myocarditis on convalescent myocardial health, symptoms, and clinical outcomes. Methods: This study was performed at two tertiary care hospitals. Baseline and convalescent (≥3 month) CMR imaging was performed for 20 consecutive patients meeting Updated Lake Louise Criteria for acute myocarditis within 10 days of mRNA-based vaccination and with no evidence of active viral infection. Global and segmental CMR-based markers of myocardial injury were studied at baseline and convalescence, inclusive of chamber volumetry, LV ejection fraction (LVEF), LV mass, T1 and T2 mapping, late gadolinium enhancement (LGE) imaging, and extracellular volume (ECV) fraction. Major clinical outcomes were captured. Results: The median age was 23.1 years (range 18-39 years) with 17 (85%) being male. Convalescent CMR evaluations were performed at a median (IQR) of 3.7 (3.3-6.2) months. Five patients (25%) had a baseline LVEF &lt;50%. All patients showed abnormal LGE inclusive of a sub-epicardial pattern with a mean LGE burden of 8.6+/-5.3% LV mass using a &gt;5SD of reference threshold. At follow-up, a mean 3% absolute improvement in LVEF was observed, accompanied by a 7% reduction in LVEDV and 5% reduction in LV mass (all p&lt;0.015). Global LGE volume reduced by 66% (p&lt;0.001). Absolute reductions in global T2, native T1, and ECV of 2.1msec, 58msec, and 2.9%, respectively were documented (all p≤0.001). All patients with LVEF &lt;50% at baseline recovered above this threshold. However, 18 (90%) patients showed persistence of LGE at follow-up with 15% having a burden &gt;5% of the LV mass. No patient experienced major clinical outcomes. Conclusion: COVID-19 mRNA vaccine associated myocarditis shows rapid improvement in CMR-based markers of tissue edema, contractile function, and LGE, and was not associated with adverse events at intermediate range follow-up. However, convalescent fibrosis was commonly observed, justifying ongoing need for clinical surveillance in this population.
Abstract 277: Hyperoxemia Is Associated With Brain Death In Refractory Out-of-hospital Vt/vf Patients Treated With Extracorporeal Cardiopulmonary Resuscitation
Authors: Arianne Agdamag, Alejandra Gutierrez, Rajat Kalra, Andrea M Elliott, Alexandra Marquez, Tamas Alexy, Demetris Yannopoulos, Jason Bartos
Journal: Circulation (2022)

Background: Brain death is a major cause of death among refractory ventricular tachycardia/ventricular fibrillation (VT/VF) out-of-hospital cardiac arrest (OHCA) who are treated with extracorporeal cardiopulmonary resuscitation (ECPR). Studies regarding the clinical consequences of hyperoxemia in this population are lacking. We aimed to determine whether hyperoxemia (PaO 2 &gt;300mmHg) is associated with brain death in patients treated with an established ECPR protocol. Methodology: This single-center retrospective study included consecutive patients presenting to the University of Minnesota between 2015-2021 with refractory VT/VF OHCA. All patients were treated with an ECPR protocol including VA-ECMO. All blood gases collected within the first 48 hours were reviewed and the highest and lowest values for PaO2, PaCO2, and lactate were recorded. The primary outcome was brain death. This was defined as a lack of brainstem reflexes on physical examination and herniation on CT imaging or lack of blood flow on a brain perfusion scan. Results: One-hundred and eighty-two patients met inclusion criteria and 141/182 (77.5%) had hyperoxemia. Presenting characteristics were comparable in both groups aside from higher initial PaCO 2 in patients who developed hyperoxemia ( Figure ). Brain death occurred in 42/141 (29.8%) of the hyperoxemia group vs 3/41 (7.3%) in the non-hyperoxemia group. After adjustment for age, CPR time, initial PaCO 2 and lactate, hyperoxemia was significantly associated with brain death (OR 5.2, 95% CI 1.4-19.0, p=0.014). The risk was independent of the number of hours spent with hyperoxemia ( Figure ). Overall survival was comparable between groups. Hypoxemia (PaO2 &lt;60mmHg) occurred in 76/182 (41.8%) and was not associated with survival or brain death. Conclusion: Among refractory VT/VF OHCA patients treated with ECPR, hyperoxemia after the cardiac arrest is associated with brain death independent of the number of hours spent with hyperoxemia.